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Life Insurance Questionnaire
Complete this form so that we may provide you with a quote for Life Insurance that best matches your needs and desires. You may receive a call asking for more detailed information.
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Address
*
Your answer
Mobile Number
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Gender*
*
Male
Female
Marital Status
*
Married
Single
Could you tell us all the different types of insurance you currently have?
*
Life Insurance
Term Insurance
Critical Illness
Unit-linked Insurance
Medical/Health Insurance
Personal Accident Insurance
Auto/Car Insurance
Travel Insurance
Retirement Plan
Burial Plan
Do not own one
Other:
Required
Now, thinking of all the personal insurance policies you currently have, how much in total are you covered for death cover only?
*
Less than Php50,000
Php50,001 - Php100,000
Php100,001 - Php300,000
Php300,001 - Php500,000
Php500,001 - Php750,000
Php750,001 - Php1,000,000
Php1,000,001 - Php1,500,000
Php1,500,001 - Php3,000,000
Do not know/can't recall
Other:
What are the reasons why you do not own any insurance (besides those brought by your employer)?
*
It's too expensive
Insurance is not important, no reason to get it
It is not necessary or worth doing
It is too hard to understand/confusing
I do not trust insurance companies
It is too much hassle to get
It is not worth of good value
Employer sponsored cover is sufficient for me
Insurance is not worth investing
I am well-covered by my employer
I am afraid to commit for long-term payment
All of them
Other:
Required
Please tell us how well do you think you are covered?
*
Definitely well-covered
Probably well-covered
May or may not be well-covered
Probably not well-covered
Definitely not well-covered
How long do you think the death cover amount will cover your family/beneficiaries?
*
Less than 1 year
1-3 years
4-7 years
8-10 years
11-15 years
More than 15 years
Do not know/can't recall
Please tell us if you have any plans to get insurance?
*
Definitely have plans to buy
Probably have plans to buy
May/May not have plans to buy
Probably have no plans to buy
Definitely have no plans to buy
When is the most convenient time for us to call or message you?
*
Your answer
A copy of your responses will be emailed to the address you provided.
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